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Does Va Pay For Kidney Transplant

If Your Claim Is Denied

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If your VA disability application gets denied, dont give up hope. You can always appeal this decision, including sending it all the way up to the CAVC if needed. You can also appeal if you feel the rating you got is too low and doesnt reflect your condition accurately.

If you decide to appeal your VA disability decision, its a good idea to hire a lawyer specializing in veteran law. For one thing, they can help you navigate the confusing world of deadlines, paperwork, and evidence. But they can also give you inside tips and tricks to get the highest compensation possible.

A behind the scenes look at who works for you at Woods and Woods, The Veterans Firm.

How Does The Va Rate Kidney Disease

If youre a veteran with kidney disease, you may be eligible for disability benefits. The VA will consider several factors when rating this disease.

The VA rates kidney disease under the genitourinary system. There are two separate rating schedules: one for dysfunctions and one for diagnoses . In most cases, the rating code for diagnoses will reference the dysfunctions rating code for proper evaluation of the severity of the condition.

For example if you have chronic kidney disease, and now require regular dialysis, the VA is supposed to rate your condition under Chronic renal disease requiring regular dialysis . In addition, this particular rating code requires the VA rater to consider renal dysfunctions when evaluating your condition, under the dysfunctions rating schedule.

The VA rates chronic kidney disease primarily as a renal dysfunction, and has 5 rating percentages for this condition: 0 percent, 30 percent, 60 percent, 80 percent, and 100 percent. These percentages are based on:

  • The amount of albuminuria present in a urine sample, with edema AND/OR
  • The amount of waste collected in a blood test OR
  • A rating of high blood pressure under the VAs diagnostic code OR
  • Generalized poor health

Kidney Conditions And Va Disability Benefits

Why Are Kidney Conditions Important?

The kidneys are responsible for cleaning the blood of toxins and transforming those waste products into urine. This function is one of the most important in the body because without the balance the kidneys provide by removing wastes and excess water, the nerves, muscles, and other bodily tissues may not work properly. The kidneys also produce hormones that can help control blood pressure, keep bones strong and healthy, and make red blood cells.

Given how important the kidneys are for bodily functioning, it can be devastating when someone develops a condition that damages or limits the output of the kidneys. Due to the many possible causes of different kidney conditions, the VA provides compensation to veterans who can show that their kidney condition results from their military service. The kidney conditions which the VA provides compensation for include, but are not limited to, the following:

  • Kidney removal
  • Tuberculosis of the kidney
  • Kidney transplant
  • Renal tubular disorders

How The VA Rates Kidney Conditions

Under 38 CFR § 4.115a, the VA rates most kidney disorders under the disability rating schedule for renal dysfunction. A more expansive list of the types of kidney disorders the VA rates can be found under 38 CFR § 4.115b.

Renal dysfunction:

Help With Your VA Claim

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Charles Nelson A Disabled Army Veteran Needed A Kidney Transplant And Luckily His Son Coty Nelson Was A Match But The Us Department Of Veterans Affairs Wouldn’t Cover The Transplant Because His Son Was Not A Veteran

Charles and Coty Nelson at Coty’s wedding, which Charles officiated.

When Charles, a former Army Specialist, attempted to get approval from his Veteran Affairs Choice Program healthcare provider, he was told he wasn’t eligible for coverage because his son was not a veteran.

The program available to veterans who live more than 40 miles away from a VA transplant facility only allows veterans to receive transplants from other veterans.

“If you know about transplants, you know it’s hard enough to find a non-veteran donor,” Charles told BuzzFeed News.

Charles, 48, and his wife Tamara Nelson decided to raise the money to cover their son’s half of the surgery, but the VA told them the Choice Program still would not cover it, because it “was really just one kind of surgery” for both people, she said.

“The VA is kind of a joke,” Tamara Nelson told BuzzFeed News. “We love our doctors and could not be happier with them, but the bureaucratic bullshit makes this all so hard.”

The Department of Veterans Affairs did not immediately respond to a BuzzFeed News request for comment.

Specialist Charles Nelson caught strep throat when he was stationed in South Korea in 1988. After going untreated, it eventually turned into a kidney disease. This will be his second transplant.

Va Disability Ratings For Kidney Diseases And Secondary Conditions

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Veterans suffering from kidney disease should find out if their condition is service connected. If so, they can receive VA disability benefits every month.

These days, we hear a lot about cleanses, detoxes, and clean diets that supposedly remove dangerous toxins from our bodies and leave us feeling more energetic and healthier. But did you know your body has its own natural detox system? Your kidneys are responsible for removing unneeded waste from your body, but what happens when this system breaks down?

Kidney disease is a serious condition, and if you served in the military, you could be eligible for compensation from the VA for this disease. Read on to learn more about kidney disease and answer the question, What is the VA disability rating for kidney disease?

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Diabetes & Kidney Disease: Whats The Connection

Many veterans will qualify for secondary service connection for their kidney disease. Specifically, this may occur when they have kidney disease secondary to diabetes.

Type II Diabetes is not only an increasingly prevalent condition among United States citizens, but also among the veterans who served during the Vietnam Era. In its Special 2000 Update, the Institute of Medicine officially recognized Diabetes Mellitus II as a health effect of exposure to the chemical Agent Orange, and established it as a presumptively service-connected condition under the qualifying circumstances.

As any diabetic can tell you, diabetes is not an isolated disease. It affects the rest of the body in a number of damaging ways. One of these is kidney disease. According to the American Heart Association, renal disease is a common, often severe complication of diabetes. Likewise, according to the National Institute of Diabetes and Digestive and Kidney Diseases , diabetes is the leading cause of chronic kidney disease and kidney failure in the US, accounting for nearly 44% of new cases of kidney failure.

Preparing For Your Appointment

Before you go to your appointment, there are some things you should do to ensure it goes as smoothly as possible and you get the diagnosis you need. Start by putting together a personal and family medical history, including any previous diagnoses youve gotten and a list of procedures youve had performed. You should also write up a family medical history, being sure to include any cases of a blood relative getting diagnosed with a kidney disease of any sort.

You may also have questions for your doctor throughout the diagnostic process. These can be hard to remember once youre in the exam room, so make note of them before you go to your appointment. You may also want to take notes during the exam in case you have any follow-up questions later.

Here are some tips on your C& P exam from one of our VA disability lawyers.

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Tamara Refused To Give Up And Kept Calling The Va To Get Them To Cover It Every Time I Called Somebody I Was Stonewalled She Said Until The Family Spoke To The Press

The whole Nelson family with Charles and Tamara in the middle.

“After we were on TV the VA called from the government side in D.C. to apologize,” Tamara said, referring to a local TV news segment that aired Tuesday.

Waiting on the VA only made matters worse, Tamara said. Because they had to postpone the transplant, Charles had to start dialysis a process that those with a live kidney donor are told to avoid.

The VA assured them on Wednesday that they would pay for the deductibles instead, and the Nelsons would pay nothing out of pocket.

“But, like before, it’s all been verbal,” Tamara said. “Still there’s no documentation, so we’ll see.”

Presumptive Service Connectionagent Orange

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A presumption of exposure means that if a veteran has qualifying service, VA will presume that they were exposed to certain harmful chemicals or environmental hazards. If VA concedes exposure and you later develop certain health conditions, you may be eligible for service connection on a presumptive basis.

Coronary artery disease is an example of a condition that may warrant presumptive service connection. Specifically, veterans with coronary artery disease who served in Vietnam between January 9, 1962 and May 7, 1975 should receive VA disability benefits under this presumption.

However, the presumption of service connection only applies to coronary artery disease. Hypertension is not currently a presumptive condition associated with herbicide exposure. In 2018, the National Academy of Sciences , which conducts biannual reviews of the evidence linking certain conditions to herbicide exposure, finally indicated that there was sufficient evidence linking the development of hypertension with Agent Orange exposure.

There has since been communication from VA that hypertension would be added as a presumptive condition however, no action has been taken. Nonetheless, even though hypertension is not a presumptive condition, veterans can still receive service-connected compensation. The NAS report is very persuasive, so submitting that along with additional evidence can be another path to getting service connection for hypertension.

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Study: Short Supply Of Centers Impacts Transplant Rates For Veterans

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In most cases, U.S. veterans are less likely to get a kidney transplant compared to individuals with Medicare or private insurance, according to a recently published study.

After successful listing, VA kidney transplant candidates appear to have persistent barriers to transplant, wrote Joshua J. Augustine, MD, and colleagues from the Cleveland Clinic, Case Western University School of Medicine, the Louis Stokes Veterans Administration Hospital and the Populations Health Research in Cleveland. Further contemporary analyses are needed to account for variables that contribute to such differential transplant rates.

Veterans have a higher rate of kidney disease compared with the general population, and kidney transplant outcomes in VA patients have been comparable to the general population, the authors wrote. VA patients do benefit from universal coverage of immunosuppressive therapy, with low or absent copays after transplantation.

The high cost of immunosuppressive medications has been shown to be a deterrent to transplantation in the general population, and VA benefits may help to eliminate this barrier, the authors wrote.

However, the VA has seven kidney transplant centers available across the country, possibly explaining why 15% of veterans who get kidney transplants use VA centers for the surgery, the authors wrote.

The Nso Does Not Determine The Number And Location Of Vatcs

Not all VA medical facilities become a VATC even though facility leadership and providers may claim intent or desire. Since 2009, the VHA has had a policy that defines the process for new clinical program approval including transplant programs. The VA medical facility develops a business plan that details the transplant program to be established, intended benefits to Veteran care, costs, and steps to activation including hiring of providers and staff, purchasing of technology, contracting, and required construction, if applicable. The VA medical facility submits the business plan to the regional office, the Veterans Integrated Service Network . Following review and approval, the VISN Director submits the business plan to VA Central Office, specifically the Deputy Under Secretary for Health for Operations and Management . The DUSHOM then distributes the business plan to multiple program offices, including the NSO, for evaluation.

The USH has ultimate authority to approve or deny the activation of any proposed program. The process from VISN Director business plan submission to USH approval may take 4-6 months or longer if there are complicating factors. Once approved, the in-house VATCs will need time to obtain UNOS certification and the integrated VATCs will need time to finalize a contract for transplant services with the affiliate. In addition, upon approval, the NSO collaborates with the VATC regarding timing for program activation in TRACER.

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How Are Bone Marrow Transplants Rated Anyway

For any condition included in the Federal Register for which bone marrow transplant is a viable and required treatment method, the condition is rated at 100 starting on the date of your hospital admission, and continuing on for six months from your discharge date. At that point you must attend a mandatory VA examination to evaluate your current health and submit to a potential change to your rating.

The VA routinely fails to properly evaluate Veterans service-connected conditions requiring bone marrow transplants. Its critical you have a knowledgeable attorney review your file to ensure the VA assigned the proper evaluation. Also, theres likely a host of additional medical conditions attributable to your transplant that you are eligible to receive additional compensation for. However, action may be required by the Veteran to initiate such considerations.

The Va Has Authority To Refer Veterans For Community Care

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The MISSION Act was preceded by the Veterans Access, Choice, and Accountability Act of 2014 , mandating the VA to authorize Community Care when access or distance thresholds were met for VHA care and services. The Choice Act and its enabling regulations unintentionally presented a barrier to Community Care for transplant services by effectively limiting what VA could reimburse for organ procurement and living donor procedures. Moreover, non-VA providers participation in the Veterans Choice Program is optional. The MISSION Act requires the Veterans Choice Program to sunset in June 2019 .

For years, the VA has utilized 38 U.S.C. §8153 authority to contract for transplant services with a non-VA transplant center when VHA care and services were not feasibly accessible. The 8153 contract, so-called medical sharing agreement, allows for all transplant-related costs, including organ procurement and living donation if needed, to be negotiated and mutually agreed-upon. The VHA Medical Sharing Office in collaboration with the NSO has developed a template to facilitate the 8153-contracting process for Community Care transplant services when needed.

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Getting A Medical Nexus

With your diagnosis and service connection established, it will be time to get a medical nexus for your condition. In essence, a medical nexus is an official statement from your doctor confirming that your condition was at least as likely as not caused by the incident in your service record. Your diagnosing doctor should be able to provide this nexus for you.

If possible, get a copy of your military service record before you go to your diagnostic appointment. With this in hand, you can get your medical nexus the same day as your diagnosis. This could help to speed along your VA disability application and get you the compensation you deserve sooner.

The Nexus Letter is like the missing link to a successful VA disability compensation claim. In this video, one of our veterans disability lawyers explains the importance of the Nexus Letter.

How The Va Evaluates Disability Claims For Kidney Disease

The VA ratings for renal dysfunction are:

  • 100%: Requiring regular dialysis, or precluding more than sedentary activity from one of the following: Persistent edema and albuminuria or, BUN more than 80 mg% or, creatinine more than 8 mg% or, markedly decreased function of kidney or other organ systems, especially cardiovascular.
  • 80%: Persistent edema and albuminuria with BUN 40 to 80 mg% or, creatinine 4 to 8 mg% or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion.
  • 60%: Constant albuminuria with some edema or, definite decrease in kidney function or, hypertension at least 40 percent disabling under diagnostic code 7101.
  • 30%: Albumin constant or recurring with hyaline and granular casts or red blood cells or, transient or slight edema or hypertension at least 10 percent disabling under diagnostic code 7101.
  • 0%: Albumin and casts with a history of acute nephritis or, hypertension non-compensable under diagnostic code 7101.

As mentioned above, if you require regular dialysis for your end-stage kidney failure, you are entitled to a 100% rating, because one of the rating requirements for the 100% rating is regular dialysis. Alternatively, you are entitled to a 100% rating if:

  • You experience persistent edema and albuminuria with a BUN of 40 to 80mg, or creatinine of 4 to 8 mg OR
  • You experience generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion

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How Does Va Rate Kidney Disease

Veterans with kidney disease may qualify for disability compensation benefits from VA. VA rates kidney disease under the genitourinary system. The genitourinary system includes both the organs of the reproductive system and the urinary system. Specifically, kidney diseases are rated under 38 CFR § 4.115a, Ratings of the Genitourinary System dysfunctions, using the criteria for renal dysfunction. The criteria for each disability rating are as follows:

  • 100% requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria or, BUN more than 80mg% or, creatinine more than 8mg% or, markedly decreased function of kidney or other organ systems especially cardiovascular
  • 80% persistent edema and albuminuria with BUN 40 to 80mg% or, creatinine 4 to 8mg% or, generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion
  • 60% constant albuminuria with some edema or, definite decrease in kidney function or, hypertension at least 40% disabling under DC 7101
  • 30% albumin constant or recurring with hyaline and granular casts or red blood cells or, transient or slight edema or hypertension at least 10% disabling under DC 7101
  • 0% albumin and casts with acute nephritis or, hypertension non-compensable under DC 7101


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